Abstract
Purpose
Depression following major cardiac events is associated with higher mortality, but
little is known about whether this can be reduced through treatment including cardiac
rehabilitation and exercise training. We evaluated the impact of cardiac rehabilitation
on depression and its associated mortality in coronary patients.
Patients and Methods
We evaluated 522 consecutive coronary patients (381 men, 141 women; aged 64±10 years) enrolled in cardiac rehabilitation from January 2000 to July 2005 and a
control group of 179 patients not completing rehabilitation. Depressive symptoms were
assessed by questionnaire at baseline and following rehabilitation, and mortality
was evaluated after a mean follow-up of 1296±551 days.
Results
Prevalence of depressive symptoms decreased 63% following rehabilitation, from 17%
to 6% (P <.0001). Depressed patients following rehabilitation had an over 4-fold higher mortality
than nondepressed patients (22% vs 5%, P=.0004). Depressed patients who completed rehabilitation had a 73% lower mortality
(8% vs 30%; P=.0005) compared with control depressed subjects who did not complete rehabilitation.
Reductions in depressive symptoms and its associated mortality were related to improvements
in fitness; however, similar reductions were noted in those with either modest or
marked increases in exercise capacity.
Conclusion
In patients following major coronary events, cardiac rehabilitation is associated
with both reductions in depressive symptoms and the excess mortality associated with
it. Moreover, only mild improvements in levels of fitness appear to be needed to produce
these benefits on depressive symptoms and its associated mortality.
Keywords
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© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
